Race and Health Outcomes Associated with Obesity

2010年健康人的两个首要目标是增加健康生活的年限和质量，以及消除 健康差距。因为肥胖对非洲和西班牙裔美国人的影响不成比例，理解 种族对肥胖对不同健康结果的影响对于实现这些目标尤为重要。 有趣的是，尽管非洲裔美国人(AA)的预期寿命仍然大大低于白人， 观察性研究表明，肥胖对aa人群死亡率的影响可能比白人低，尽管 肥胖美国人的医疗支出低于肥胖的美国白人。 与肥胖相关的死亡率和成本的种族差异可能反映了几个方面的差异：更高 AAS中相互竞争的健康风险，如吸烟、艾滋病毒和创伤的比率；肥胖和 腹主动脉的心血管危险因素；以及正常体重的腹主动脉危险因素的诊断和治疗延迟。vbl.使用 来自3个国家数据库的数据-医疗保险当前受益人调查(MCBS)、国家健康和营养 检查调查(NHANES)和医疗费用小组调查(MEP)-本研究将审查 种族和体重指数(BMI)的相互作用与4个重要结果有关：1)死亡率；2)心血管风险 这些因素包括：3)心血管危险因素的诊断和治疗延误；4)医疗保健支出。上一首 检查肥胖相关死亡率的研究还不能充分解决与健康风险竞争的问题 以及吸烟和临床前疾病带来的残留混淆，这可能会模糊肥胖和 更高的死亡率。由于MCBS数据与联邦医疗保险索赔是纵向联系的，这项研究将能够限制 不受控制的吸烟和临床前疾病的混杂以及相互竞争的健康风险。此外，这些研究 在这项申请中提出的将解决几个重要的问题：肥胖和新奇 与白人相比，心血管危险因素减少了吗？是较瘦的少数族裔成年人，对一些人来说，他们可能面临更高的风险 心血管危险因素比他们的体重指数预测的更容易延误诊断和 如何处理这些危险因素？导致种族差异的不同类型的护理和医疗条件是什么 在与肥胖相关的医疗支出中？在澄清这些关系时，我们的发现可能会揭示 肥胖相关风险和成本的种族差异背后的机制。我们的发现也可以指导 公共卫生优先事项以及针对减少医疗保健和死亡率方面的种族差异的具体举措。

Two overarching goals of Healthy People 2010 are to increase years and quality of healthy life and to eliminate health disparities. Because obesity disproportionately affects African and Hispanic Americans, understanding the influence of race on obesity's impact on different health outcomes is especially vital to achieving these goals. Interestingly, although African Americans (AAs) continue to have substantially lower life-expectancy than whites, observational studies suggest that obesity may have a lower impact on mortality in AAs than in whites even though healthcare expenditures in obese AAs are lower than in obese white Americans. Racial differences in obesity-related mortality and cost may be a reflection of differences on several fronts: higher rates of competing health risks such as smoking, HIV, and trauma in AAs; a reduced association between obesity and cardiovascular risk factors in AAs; and delays in diagnosis and treatment of risk factors in normal-weight AAs. Using data from 3 national databases -the Medicare Current Beneficiary Survey (MCBS), National Health and Nutrition Examination Survey (NHANES), and Medical Expenditures Panel Survey (MEPS)- this study will examine the interplay of race and body mass index (BMI) as they relate to 4 important outcomes: 1) mortality; 2) cardiovascular risk factors; 3) delays in diagnosis and treatment of cardiovascular risk factors; and 4) healthcare expenditures. Previous studies examining obesity-related mortality have not been able to adequately address the issue of competinghealth risks and residual confounding from smoking and preclinical illness, which can obscure an association between obesity and higher mortality. Because MCBS data are linked to Medicare claims longitudinally, this study will be able to limit uncontrolled confounding from smoking and pre-clinical disease and competing health risks. Furthermore, the studies proposed in this application will address several important questions: Is the association between obesity and novel cardiovascular risk factors reduced compared to whites? Are leaner minority adults, who may be at higher risk for some cardiovascular risk factors than predicted by their body mass index, more susceptible to having delays in diagnosis and treatment of these risk factors? What are the different types of care and medical conditions that drive racial differences in obesity-related healthcare expenditures? In clarifying these relationships, our findings could shed light on mechanisms underlying racial differences in obesity-related risk and cost. Our findings could also guide the setting of public health priorities and the targeting of specific initiatives to reduce racial disparities in healthcare and mortality.